Guidelines for Performing Oesophagogastroduodenoscopy (OGD) with Biopsy

Pre-procedure Preparation

Patients should be assessed for fitness to undergo a diagnostic OGD prior to the procedure, and receive appropriate information about the procedure before undergoing an OGD, with informed consent obtained before performing an OGD 1
An appropriate time slot of at least 20 minutes should be allocated for a standard diagnostic endoscopy, with longer slots for surveillance or high-risk conditions 2
A safety checklist should be completed before starting an OGD 1

Only an endoscopist with appropriate training and relevant competencies should independently perform OGD, and aim to perform a minimum of 100 OGDs per year to maintain high-quality examination standards 1
UGI endoscopy should be performed with high-definition video endoscopy systems, with the ability to capture images and take biopsies 1

A complete OGD should assess all relevant anatomical landmarks and high-risk stations, with photo-documentation made of relevant anatomical landmarks and any detected lesions 1, 3
The quality of mucosal visualization should be reported, and adequate mucosal visualization should be achieved by a combination of adequate air insufflation, aspiration and the use of mucosal cleansing techniques 1
For surveillance procedures, inspection time during diagnostic OGD should be recorded 1

For Barrett's Esophagus, the length of a Barrett's segment should be classified according to the Prague classification, and biopsies should be taken in accordance with the Seattle protocol (quadrantic biopsies at 2 cm intervals) 1, 4
For Eosinophilic Esophagitis, biopsies from two different regions in the esophagus should be taken to rule out eosinophilic esophagitis in those presenting with dysphagia/food bolus obstruction, where an alternate cause is not found 1, 5
For Esophageal Ulcers and Severe Esophagitis, oesophageal ulcers and esophagitis that is grade D or atypical in appearance should be biopsied, with further evaluation in 6 weeks after PPI therapy 1, 4
For Squamous Neoplasia, if squamous neoplasia is suspected, full assessment with enhanced imaging and/or Lugol's chromo-endoscopy is required 1
For Strictures, strictures should be biopsied to exclude malignancy before dilatation, and all strictures should be biopsied for histological analysis to exclude malignancy and eosinophilic esophagitis 1, 6

For Gastric Ulcers, gastric ulcers should be biopsied and re-evaluated after appropriate treatment, including H. pylori eradication where indicated, within 6-8 weeks 1, 3
For Gastric Atrophy or Intestinal Metaplasia, where there are endoscopic features of gastric atrophy or intestinal metaplasia, separate biopsies from the gastric antrum and body should be taken 1, 3
For Gastric Polyps, the presence of gastric polyps should be recorded, with the number, size, location and morphology described, and representative biopsies taken 1, 8

A malignant-looking lesion should be described, photo-documented and a minimum of six biopsies taken 1, 8
When investigating iron deficiency anemia, separate biopsies from the gastric antrum and body should be taken, as well as duodenal specimens if celiac serology is positive or has not been previously measured 1

A checklist should be undertaken after completing an OGD, before the patient leaves the room, and after OGD, readmission, mortality, and complications should be audited 1, 7
A report summarizing the endoscopy findings and recommendations should be produced and key information provided to the patient before discharge 1
A method for ensuring histological results are processed must be in place, and endoscopy units should audit rates of failing to diagnose cancer at endoscopy 1

Failure to follow standardized biopsy protocols for specific conditions (e.g., Seattle protocol for Barrett's) can lead to missed diagnoses 1, 4
Not re-evaluating gastric ulcers after treatment can result in missed malignancy 1
Inadequate mucosal visualization due to poor technique or preparation can lead to missed lesions 1